List of insurance cases under compulsory motor insurance. Insured events and exceptions for mortgage insurance What circumstances constitute an insured event

Insurance is a way to guarantee financial assistance to yourself or your family in the event of certain events.

An insured event is precisely those events for which compensation is due; they are specified in the insurance contract.

Each insurance company, in the terms of the contract, specifies its own list of such situations, upon the occurrence of which compensation is provided.

For life and health insurance against accidents

Such insurance is relatively inexpensive, since it covers a small list of risks. The main points regarding insured persons due to an accident are:

• death;
• establishment of full working capacity;
• establishing temporary working capacity;

That is, with such insurance, the insured event is a sharp deterioration in health or death of the insured person. Not everything is so simple, insurance companies cannot be easily deceived and enter into an agreement knowing about your health problems.

If such an insured accident occurred as a result of chronic illnesses or other ailments that the client knew about but did not disclose at the time of concluding the contract, then it will not be recognized due to the concealment of facts affecting the amount of insurance payments.

Such insurance is also called social insurance, since the same risks are included in compulsory social insurance.

For property insurance of high-level cardholders

Typically, such insurance is available to holders of MasterCard Standard and higher plastic cards. The list of covered risks includes:

• loss/theft of plastic cards;
• loss/theft of wallet;
• loss/theft of goods purchased using this card;
• loss/theft of documents.

Often the occurrence of an insured event under these points is limited in time - about 2-4 hours from the moment of the incident. This means that if you have not reported it missing within this time, you will not be paid. In addition, you must report the theft to the police.

For medical insurance of persons traveling abroad

This insurance can be purchased separately or as an addition to other banking products. For example, plastic cards of the Gold, Platinum, and Premium classes often include this option in the cost of settlement and cash services and cover the following risks:

• severe toothache, dental services abroad;
• treatment of inflammatory processes;
• repatriation of the body.

That is, with this type of contract, the insured event is various health problems that may occur to the cardholder.

Moreover, all such insured events are confirmed by a specific document that must be properly executed. Also, the attending physician must admit that it was necessary to treat the insured person urgently, so postponing treatment until he arrives home would be unacceptable.

In health insurance

Such insurance is not common in the Russian Federation. It is relevant in those countries where it is mandatory, for example, in the United States of America. Basically, all injuries, temporary loss of ability to work or its complete loss, disability, death - this is an insured event. Insurance implies payment if it occurs as a result of the following events:

• natural disasters;
• burns;
• explosions;
• drowning;
• frostbite;
• lightning strike;
• action of electric current;
• illegal actions of third parties or animals;
• sunstroke;
• falling objects;
• the insured person falls from a height;
• foreign objects entering the respiratory tract;
• strangulation due to unforeseen events;
• use of automotive, household appliances, etc.

Gradually and very slowly, this type of insurance is developing in the Russian Federation.

IN OSAGO

In this type of service, the insured event is the infliction of losses to third parties in the process of participation in road traffic:

• property;
• health (including passengers).

However, these situations will not be such cases if they occurred in the case of a gross violation of traffic rules and (or) in a state of drug and (or) alcohol intoxication, and (or) driving through a prohibitory traffic light sign.

Car insurance CASCO

Unlike the above types of insurance, each insurance case in CASCO is individual for each insurer, but the most popular are the following:

• illegal actions of third parties (hijacking or theft of car components);
• accidents;
• natural disasters (large hail, wind, falling trees);
• other events (for example, flooding of a car in a parking lot due to a sewerage problem).

That is, an insured event is various damage to a car that occurred due to circumstances beyond the control of the insured.

However, in cases of alcohol or drug intoxication, gross violations of traffic rules and driving through a red light, insurance compensation is not provided.

When insuring commercial or non-commercial real estate

This is a rather unpopular type of insurance, especially in relation to residential real estate, although insurance companies often offer a wide range of covered risks:

• damage to the interior decoration of the apartment/house due to flooding by neighbors;
• similar damage due to weather conditions (for example, earthquakes);
• breakdown of household appliances and electrical appliances due to power surges or other factors.

To compensate for damage to household appliances, a mandatory condition will be the presence of a receipt and documents for such products, which could damage ownership rights.

Some insurers also add to the list the life and health of one family member living in the insured apartment/house if he is physically damaged as a result of property destruction.

Insured event when insuring goods

Such insurance is often offered when taking out a consumer loan at retail outlets. This type of insurance allows you to cover the following insured events:

• factory defect;
• breakdown of electronic mechanisms;
• mechanical damage to the goods associated with the delivery of goods to the client.

Such damage is quite difficult to prove, so it is worth testing the product when purchasing it in a store, as well as immediately after it is delivered to its destination (home).

What are the nuances that can affect the amount of insurance compensation?

Simply the occurrence of an insured event is not enough to provide guaranteed compensation for damage - it is necessary to report the incident to the insurer, who will send an emergency commissioner to record the event.

In addition, the insurance company will calculate the damage incurred by the other party to the contract in order to pay the insurance compensation.

At this point, many people come across who want to get a large list of covered insurance events for pennies. After all, this list will not guarantee complete protection, but may only be a trick.

It is always necessary to look at the following points of the insurance contract:

1. Franchise size. The following example can be given:

Very often, car owners insure their cars under the CASCO program in the hope that the slightest scratch will be compensated. To save money, the insurance company may offer a high deductible.

The bottom line is that the minimum threshold that must be overcome depends on its level in order for you to start paying something. If a car costs 200,000 rubles, and the deductible is set at 2 percent, then if the car is damaged in the amount of up to 4,000 rubles. no payments will be made, and you need to rely only on your finances.

2. Level of sum insured. Suppose a person wanted to insure the apartment in which he lives. Often, insurance companies prefer not to go to the site to assess the possible amount of property and offer clients to evaluate it themselves.

If a person wants to “save” and insure for a smaller amount, then in the end he will receive a proportional compensation, that is, the amount of damage will be adjusted by a reducing factor. In the case of insuring an apartment for a larger amount than it actually is, a similar situation does not occur, and the client will receive exactly the amount of actual damage.

3. Possibility of changing the sum insured by the amount of compensation paid. There are situations when insured events occur during the validity of one insurance contract.

There may be two scenarios: the insured amount does not decrease or its level decreases by the amount of compensation paid. In the second option, the payment under the contract will be noticeably less, but the compensation, naturally, will be lower.

If an insured event occurs, you must immediately notify the insurer

The most important thing is to notify the insurance company. And this needs to be done as quickly as possible. Only in this case can you be guaranteed to receive a refund. Otherwise, the insurer will be able to refuse you, based on various clauses of the contract that indicate the need for immediate notification.

When an insured event occurs, policy owners have a reasonable question - how to receive payment from the insurer in full. According to the standard terms of the insurance contract, in order to receive payment, you need to prepare a package of documents and prove that the event falls under the conditions for payment of compensation. And if everything is completed correctly, the company will make a payment to the policyholder.

But in practice, obtaining compensation is not always easy. Insurance companies often make a number of stringent requirements and often refuse compensation for one reason or another, leaving the policyholder with no choice but to obtain compensation from the company through legal proceedings. In this article we will highlight the question - what forms of compensation under a life insurance contract exist, how and in what order can they be received?

Forms of payment of insurance compensation

In accordance with the standard terms of a life insurance contract, compensation can be paid in several ways:

• in the form of monetary compensation for expenses incurred upon the occurrence of an insured event that led to disability or death of a person;
• in the form of an accumulated amount previously deposited by the policyholder into a savings account - usually operates within the framework of pension plans, as well as life insurance programs.

Within the framework of endowment insurance, payment can be made in the entire amount at once, or distributed over several years. In case of sudden death of the insured person, the compensation will be paid to the beneficiary specified in the contract.

Standard conditions for payment of compensation

The specific conditions for making payments are usually specified in detail in the insurance contract, and can vary greatly depending on the type and conditions of the program. At the same time, the general requirement for payment of compensation is the occurrence of an event provided for in the contract. In life insurance, such cases include:

• reaching the age specified in the policy;
• death of a person due to reasons beyond his control;
• receiving any disability group after an injury or illness;
• diagnosing a deadly disease;
• serious injury as a result of an accident or unlawful actions of third parties;
• the need for emergency surgical treatment;
• receiving temporary disability.

Common reasons for refusal of payments

There are several reasons for an insurance company’s refusal to make payments that are a legitimate requirement of the insurer, and even going to court will not be able to change the situation. In particular, these include:

1. Notifying the insurer of the occurrence of an event later than the deadlines established by the contract. However, there are exceptions here, for example, if the cause of the delay was a long business trip, hospital treatment or other obstacles that objectively prevented the insured from reporting an accident. In this case, the applicant will be able to restore his legal rights to receive payments through the court.
2. Lack of documents confirming the occurrence of an insured event. Insurers usually clearly state in the contract a list of documents that must be presented to the applicant in order to receive compensation. Failure to provide the necessary certificates may result in a legal refusal of compensation by the insurance company.
3. Providing false information - for the purpose of material gain, many try to provide false information or even fake documents. These actions will not only lead to refusal of payment, but may also serve as a reason for initiating a criminal case.
4. The insured event is not subject to the terms of the contract. Typically, the insurance contract specifies all insured and non-insurable events as a separate clause. If the death of a person occurred as a result of an accident, then such a case can be considered insured, and if, for example, the death occurred from suicide, then such a case will be non-insurable. Also, the insurance company may find other excuses to avoid paying compensation - in this case, it is better to consult with a lawyer and then go to court.
5. Violation of the terms of the agreement - in practice, cases may occur in which the policyholder violated the terms of the agreement (for example, did not pay premiums on time), which deprives him of the right to receive compensation.

For example, a citizen who insured his life received disability by ignoring safety regulations at work. It may seem that such an event is an insured event, but since it occurred through the fault of the insured person, such an event will be considered uninsurable and the company has the right to refuse to pay compensation.

Terms of payment of compensation

Upon the occurrence of an insured event, the applicant must notify the insurer of the event as soon as possible, but no later than 30 days. This condition must be additionally specified in the contract, as well as a list of valid reasons why this period may be extended.

According to the insurance contract, documents for compensation are usually processed within 5-20 days. In practice, the period for consideration of the application can be increased to several weeks if the company has doubts about the authenticity of the documents and the reliability of the information provided by the applicant. The deadlines may also be extended in cases where law enforcement agencies were involved in the investigation of the insured event to determine the cause.

If the insurer delays time without sufficient grounds, you can go to court. However, before going to court, it is recommended to write a letter to the general director of the insurance company with a complaint about the lengthy investigation of the insured event. If this does not help, you can contact the prosecutor's office, consumer rights protection authorities and Rospotrebnadzor.

Procedure for receiving compensation

When insuring life, the general rules for registering an insured event apply. So, if an insured event occurs, the applicant must contact the insurer’s representative using the contacts specified in the policy or insurance contract, or directly contact the insurance company office.

After this, he will need to prepare an application and provide supporting documents to the extent provided for in the contract. When drawing up an application, it is mandatory to indicate:

• applicant details;
• contract or policy number;
• date and time of occurrence of the insured event;
• a detailed description of the incident.

Next, you need to submit documents to the insurance company - at this stage, a company employee must check the correctness of the application and confirm the presence of all the required documents. If the application has been completed correctly and the accompanying documents have been collected in sufficient quantities, the insured event will be registered and the documents will be submitted for consideration.

Based on the results of the check, the policyholder will receive a notification by phone or email, and if the decision is positive, he will be required to contact the insurance company again to receive payment.

Today, many insurance companies offer to notify about the occurrence of an insured event on their website. In practice, this system does not always work smoothly, but it allows you to remotely notify the insurer of the occurrence of an insured event.

Required documents

The list of documents required to consider an insured event is specified in the contract and often depends on the event that occurred. Here is a list of the main documents required to be submitted to the company:

• a statement from the beneficiary (if he is specified in the agreement) or from the legal heir;
• a document confirming the right to inherit the property of the deceased;
• applicant's passport;
• insurance policy or contract;
• certificate of death of the insured person;
• a certificate from a medical institution indicating the cause of death;
• details with bank account number.

If the insured person has suffered serious bodily injury or disability, then it may also be necessary to provide relevant certificates confirming the diagnosis and indicating the reason for the disability. Medical workers do not have the right to refuse to issue a document.

Judicial practice

Life insurance is a complex process from a legal point of view. In recent years, companies have increasingly begun to refuse payments, and in about a third of cases, policyholders manage to get the amount due only through the courts.

Example: Citizen Ivanov insured his life for the amount of 1 million rubles. While crossing the road in the wrong place, he was hit by a car, and as a result of severe injuries he died. The direct heir - Ivanov's son - contacted the company to receive compensation. But the applicant was denied payment and was motivated by the fact that the death occurred due to the negligence of the insured person. The court ruled that the company does not have the right to refuse payment under a life insurance contract, since the case falls under the insurance policy. The company was obliged to pay the entire amount provided for the risk of death.

Sometimes it is not possible to establish the cause of death, and in this case it becomes problematic to obtain the compensation specified in the contract. In this case, it may help to conduct an independent examination to clarify the cause of death of the insured person and subsequent litigation with the insurance company.

Do you want to take a test based on the article after reading it?

YesNo

The result of a road traffic incident is the emergence of obligations towards the person injured in the accident. Insured events under compulsory motor liability insurance are specified in the relevant Federal Law. But despite this, insurers go to various lengths to avoid compensating the victim for damage. Therefore, you need to know exactly what is included in an insured event, and when insurers absolutely legally refuse to pay compensation.

General concepts

An insured event under MTPL is any circumstance as a result of which the car owner driving the insured car caused damage to property and/or harm to the health of other persons in another vehicle. Under these circumstances, the insurer is obliged to compensate the damage to the injured person.

The list of circumstances recognized as uninsurable is contained in the same Law. Moreover, it is more specific than the list of those that are insurance. But more about everything.

Signs of insurance cases

So, how do you find out whether the insurance company (IC) is obliged to pay compensation or not? Events are insured if:

1. The damage was caused using an insured vehicle. Use means driving a vehicle on roads and adjacent areas intended for driving.
2. There is someone who caused the accident. There must be at least two participants: the culprit, to whom civil liability applies, and the victim (he is paid compensation by the culprit's insurer).

Insured event in case of an accident - examples:

• The driver did not have time to slow down before the traffic light and crashed into the car standing in front.
• The truck drove past a parked car and hit it.

Uninsured cases:

1. Returning to the parked car, the owner discovered a dent on its hood. There were no witnesses to the incident. Therefore, the culprit has not been identified and there will be no payment.
2. The car was damaged by a load that was poorly secured in a truck parked in the parking lot.

There is a list of situations when the victim 100% can and should receive an insurance payment:

• the driver hit a pedestrian;
• a vehicle was damaged in an accident;
• the people in the car were injured;
• property was damaged in the accident (for example, a fence).

Species

Current legislation provides for two types of insurance cases:

In the situations listed in the second case, it is not worth counting on a payment under compulsory motor liability insurance that insures not the car, but the driver’s liability. If you want to be calm about your “iron horse” in all unpredictable circumstances, you need to take out voluntary CASCO motor third party liability insurance.

Uninsured events

So, what is not an insured event? The following events fall into this category:

1. Causing harm to property or a person by cargo, the movement of which is associated with an increased risk. This type of cargo is insured separately.
2. Causing damage by driving a car that is not specified in the insurance.
3. Causing harm to the life and/or health of persons performing their official duties. In this case, compensation will be paid through the types of insurance required for employees (personal, social).
4. Compensation for moral damage and lost profits.
5. Damage to property or person was caused not by the vehicle, but directly by its driver.
6. Causing harm in specially designated areas for automobile competitions, training driving, etc.
7. Damage caused during loading and unloading operations.
8. Causing damage to architectural objects, antiques, luxury goods, cash, jewelry, etc. Compensation is made at the expense of the guilty person through the court.
9. Damage to a legal entity if damage was caused to an employee of the same organization on a vehicle owned by it.

Any of these events will be considered by the insurer as a non-insured event, and, therefore, no compensation will be paid.

OSAGO in parking lots and courtyards

According to Federal Law, these territories are considered adjacent to public roads. This means that the same requirements apply to incidents that occur on them as on the roads. For example, if cars in the courtyard of a house could not move away, and one of them was damaged, then its owner may receive an insurance payment.

The only thing is: regardless of the scale of the incident, in order to receive payment, you must submit a complete package of documents. As a rule, minor damage is caused to cars in courtyards and parking areas, so not all car owners want to bother with documents. So it turns out that the situation itself is insured, but in order to receive compensation, the victim must make a lot of effort. And for the sake of several thousand rubles, doing this is burdensome.

It’s a completely different matter when damage to cars is caused while parked. The most typical situation is careless opening of the car door. Since none of the cars is in motion, the insurer has the right to refuse to pay the victim.

Instructions for car owners after an accident

Here are the actions that should be taken by the policyholder in the event of an insured event under a compulsory motor liability insurance policy in order to receive 100% of the due remuneration:

1. Setting a date for the examination. Until this point, it is strictly prohibited to carry out car repairs. Based on the results of the technical inspection, a report is drawn up reflecting the amount of insurance compensation.
2. Direct compensation for losses in cash (to the policyholder’s bank account or through a cash register) or in kind (repairs).

So you have learned what to do after an accident in order to receive an insurance payment. After reviewing the documents submitted by the applicant, the Investigative Committee will decide whether the road incident is insurable or not. In any case, the insurer is obliged to respond no later than 20 days from the date of the client’s request. If the insurance company refuses to compensate for the damage, but you are sure that the damage received is subject to compensation, you can contact the RSA or the court.

The settlement of insurance cases under compulsory motor liability insurance often raises many questions, especially when controversial situations arise with insurance companies that refuse to recognize certain cases as insured. In this article we will try to analyze in detail in what situations a driver has the right to count on compensation for damage under a compulsory motor liability insurance policy, which cases are insurable and which are not, and what legislative norms govern this.

What law governs compulsory motor liability insurance?

Due to the fact that compulsory MTPL insurance is regulated by the relevant Federal Law No. 40 of April 25, 2002, all basic principles and concepts are recorded and documented in it. This also applies to information about the conditions for the occurrence of an insured event and its recognition as such. Therefore, if any controversial situations arise, you should refer to this document.

Summarizing the main provisions of this law, we can draw the following conclusion:

Insured events are all events in which a citizen, having a valid MTPL policy in hand, while driving a vehicle, caused harm to the life or health of other persons or the property of these persons. If such an event occurs, the company is obliged to compensate for the damage caused.

At the same time, the law also specifies an extensive list of events that are not insured events and the occurrence of which is not covered by the policy.

The version of the law dated July 3, 2016 provides for a maximum amount of compensation of 400 thousand rubles for compensation for damage to property, and 500 thousand rubles for damage to life and health.

Criteria for recognizing an event as insured

According to the above-mentioned law, an insured event under compulsory motor liability insurance occurs when two main conditions are met:

1. The presence of the culprit of the accident, in relation to whom such a concept as civil liability will apply. Accordingly, there must be at least two participants in the accident: the culprit and the victim (who will be compensated for the damage by paying him compensation from the insurance company). Here are examples of relevant insurance and non-insurance events for this situation:

   Insured event: The driver was distracted and did not have time to brake in front of a pedestrian crossing, which is why he crashed into a car in front.

   Non-insurance event: A citizen, leaving a shopping center, discovered a dent in the trunk of his car. There were no witnesses to the incident, as a result of which the culprit of the incident was not identified.

2. The damage must have occurred when the culprit used an insured vehicle (VV). According to the law, such use is recognized as driving a car associated with its movement on roads and adjacent territories on which the vehicle is intended to move. Here are examples of relevant insurance and non-insurance events for this situation:

   Insured event: A dump truck drove past a car parked in a parking lot and accidentally crashed into it.

   Non-insurance event: Poorly secured construction material fell out of a parked truck and damaged a neighboring vehicle. The fact that the truck was moving was not recorded, and, therefore, it is pointless to expect that the insurance company will cover the damage.

What cases are not covered by insurance?

According to Article 6 of the above Law “On Compulsory Motor Liability Insurance”, the following events are not recognized as insurance:

• causing damage while driving a vehicle other than that specified in the MTPL policy. Insurance is issued exclusively for the vehicle, and not for its owner;
• causing harm by cargo, the transportation of which is associated with risk. Such cargo must be insured separately by the owner;
• moral damages and lost profits incurred by the victim in an accident (estimated income that could have been received if the accident had not occurred);
• causing harm by a vehicle at competitions, during training driving and in other circumstances of this kind, occurring in places specially designed for these actions;
• causing damage to the life or health of citizens who are in the performance of their work duties in the case where such damage is compensated by a separate type of insurance (social, individual);
• the occurrence of other situations in which damage to the vehicle or property of the victim was caused directly by the driver of the vehicle;
• damage caused during loading and unloading operations;
• causing losses to the employing organization if an employee of this organization was harmed on a vehicle (for which the policy was issued);
• Damage caused to historical and cultural values ​​(architecture, antiques, etc.), cash, jewelry is compensated not by the insurance company, but directly by the culprit of the accident, usually in court.

Is it possible to have an insured event without an accident?

From the content of the Law “On Compulsory Motor Liability Insurance” it follows that if the fact of an accident has not been documented, then you should not expect that the insurance company will pay anything. As noted above, the case must be traffic related. If there is a need to insure a vehicle against all kinds of risks not related to accidents on the road (natural disasters, theft, fire, spontaneous combustion and other troubles), you must also take out a CASCO policy.

However, there is one exception to this situation. Many companies like to impose additional services on the client, one of which is damage insurance and theft insurance programs. Therefore, if the client decides to additionally include one of these programs in the policy, then, of course, upon the occurrence of the stipulated insured event, he will be paid monetary compensation.

Does OSAGO apply in courtyards and parking lots?

Many car owners are interested in the question: will the policy be valid if an accident occurs not while driving on the road, but in the parking lot or yard where the car was left? According to the content of the law, courtyards and parking lots are areas adjacent to the road, which means that exactly the same rules apply regarding incidents that occur there.

It should be remembered that for these territories there are standard requirements for documents submitted to the insurance company to receive payment. Getting into a serious accident in a parking lot is difficult and is mostly limited to minor accidents with minor damage. Given this fact, drivers often do not want to spend too much time on paperwork, make many mistakes in the documents, and ultimately the injured party is left without monetary payment.

In addition, accidents often occur in parking lots due to inattention, even when the cars of both the victim and the culprit are not in motion at all. A typical situation of this kind is careless opening of car doors, leading to damage to a nearby car. This incident is not an accident, which means the Law “On Compulsory Motor Liability Insurance” will not apply to it.

Is it possible to repair a bumper under OSAGO or replace it?

After an accident has occurred and the victim has contacted the insurer with documents for damage compensation, the company must assess the condition of the car after the accident. Based on the examination, a conclusion is made on the recommended course of action - in this context, repairing the bumper or replacing it. Of course, the amount of payment will depend entirely on the expert’s conclusion. Repairing the bumper will obviously cost insurers less, so there are often cases when the assessment of the car’s condition is biased. In such a situation, you need to apply for an examination to another organization, and transfer the resulting conclusion with the cost of repairs to the insurance company. If the organization does not want to pay the specified amount, then there is only one way out - to go to court.

It should be remembered that the modernization and tuning of the car must be officially registered, otherwise there is a possibility that compulsory motor liability insurance will not cover losses. For example, if a car crashes into the back of another car and causes an accident. At first glance, the case is clearly an insurance case. But when registering an accident, it turns out that the stylish bumper on the car is not original, and this modernization has not been registered in any way. As a result, driving such a car may be considered illegal, and the incident may be considered uninsurable. Accordingly, no compensation can be expected in such a situation. And this regulation applies to all parts and components of the machine that are not included in the basic configuration.

Conclusion

Insurance and non-insurance cases under compulsory motor liability insurance are enshrined in law and compensation for damage is carried out only in accordance with the norms of legal acts. Under compulsory motor liability insurance, the insurance company provides compensation only in the event of an accident, while minor accidents in parking lots or in the courtyards of houses also qualify as insured events.